Extranodal NK/T cell lymphoma: diagnostic challenges in a resource-constrained setting

Introduction: Extranodal natural killer/T-cell lymphoma (NKTCL)- nasal type is a rare form of non-Hodgkin lymphoma. It mainly affects the midfacial structures (the nose, oropharynx, and hypopharynx). Prognosis is generally very poor and diagnosis is often delayed in Africans because of low index of clinical suspicion and resource constraints. Case report: The patient was a 30-year-old man who presented with a 5-month history of rhinorrhea associated with blockage of the left nasal cavity. Examination revealed a fleshy left nasal mass. Incisional biopsy of the mass was reported as nonspecific chronic inflammation but the diagnosis was reviewed to non-Hodgkin lymphoma after histologic examination of the excised mass. Subsequent immunohistochemical studies established a diagnosis of NKTCL 6 months after initial presentation. The patient was placed on chemotherapy and radiotherapy. He did not have access to radiotherapy because of financial constraints and defaulted from care after he has had three cycles of chemotherapy. The patient died 4 months after defaulting. Conclusion: It is very common to miss the diagnosis of the early phase of NKTCL before the appearance of the destructive facial lesion. Low index of suspicion and constraints of resources also play a role in the delayed diagnosis and poor outcome in Africa.